Audiological and Surgical Correlates of Myringoplasty Associated with Ethnography in the Bay of Plenty, New Zealand.

INTRODUCTION: This retrospective cohort study of myringoplasty performed at Tauranga Hospital, Bay of Plenty, New Zealand from 2010 to 2020 sought to identify predictive factors for successful myringoplasty with particular consideration given to the known high prevalence of middle ear conditions in New Zealand Maori. METHODS: Outcomes were surgical success (perforation closure at 1 month) and hearing improvement, which were correlated against demographic, pathological, and surgical variables. RESULTS: 174 patients underwent 221 procedures (139 in children under 18 years old), with 66.1% of patients being New Zealand Maori and 24.7% New Zealand European ethnicity. Normalized by population demographics, New Zealand Maori were 2.3 times overrepresented, whereas New Zealand Europeans were underrepresented by 0.34 times (a 6.8 times relative treatment differential). The rate of surgical success was 84.6%, independent of patient age, gender, and ethnicity. A postauricular approach and the use of temporalis fascia grafts were both correlated with optimal success rates, whereas early postoperative infection (<1 month) was correlated with ∼3 times increased failure. Myringoplasty improved hearing in 83.1% of patients (average air-bone gap reduction of 10.7 dB). New Zealand Maori patients had ∼4 times greater preoperative conductive hearing loss compared to New Zealand Europeans, but benefited the most from myringoplasty. DISCUSSION/CONCLUSION: New Zealand Maori and pediatric populations required greater access to myringoplasty, achieving good surgical and audiological outcomes. Myringoplasty is highly effective and significantly improves hearing, particularly for New Zealand Maori. Pediatric success rates were equivalent to adults, supporting timely myringoplasty to minimize morbidity from untreated perforations.

Hearing Loss Asymmetry due to Chronic Occupational Noise Exposure.

OBJECTIVE: To determine whether occupational noise exposure causes symmetrical or asymmetrical hearing loss. STUDY DESIGN: Retrospective Case Series. SETTING: Otorhinolaryngology Specialist Centre. PATIENTS: Seven hundred forty-four reports for occupational noise-induced hearing loss (NIHL) compensation were analyzed. Subjects with at least 40% of their total hearing loss due to occupational NIHL were included. Claimants with any confounding factor that could cause asymmetric hearing loss such as history of shooting, head, or ear trauma were excluded. With the strict inclusion criteria, 83 subjects were included in the study. Claimants with ≥40%, ≥60%, and ≥80% occupational NIHL of their total hearing loss were compared. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The left ear hearing threshold compared with the right ear hearing threshold (dB) at the frequencies 0.5 to 8 kHz. RESULTS: In the total group, the left ear hearing threshold was statistically significantly higher compared with the right ear at 3 kHz (2.41 dB). In the subgroups ≥60% and ≥80% occupational NIHL of total hearing loss, the left ear hearing threshold was statistically significant higher compared with the right ear at 3 kHz, respectively, 3.81 dB and 5.53 dB and 4 kHz, respectively, 2.86 dB and 5.53 dB. An asymmetry of more than 10 dB at 3 and 4 kHz was observed in 39% and 30% of the subjects respectively. In these cases, the vast majority had more pronounced hearing loss in the left ear. CONCLUSION: Findings of this study further indicate that the left ear is more susceptible to noise exposure compared with the right ear.

The accuracy of otomicroscopy for the diagnosis of paediatric middle ear effusions.

OBJECTIVE: To determine the diagnostic accuracy of otomicroscopy performed by otolaryngology specialists for the diagnosis of paediatric middle ear effusions. METHODS: Prospective study of consecutive children receiving tympanostomy tubes between December 2004 and February 2005 within the Department of Otolaryngology-Head & Neck Surgery, Manukau Surgery Centre, Middlemore Hospital, New Zealand. Eighty-six children were included in the study. Intraoperative otomicroscopic examination of the ears was performed under general anaesthesia by two otolaryngology specialists. The presence or absence of middle ear effusion was predicted prior to myringotomy. Intraoperative myringotomy findings were used as the diagnostic reference standard. RESULTS: The prevalence of middle ear effusions was 52.6% (71/135 ears). Otomicroscopy had a sensitivity 94.4% (95% CI: 85.5-98.2), and specificity 93.8% (95% CI: 84.0-98.0). The positive predictive and negative predictive values of otomicroscopy for the identification of middle ear effusions were 94.4% (95% CI: 85.5-98.2), and 93.8% (95% CI: 84.0-98.0) respectively. The overall accuracy of otomicroscopy was 94.1%. There was an excellent level of agreement between otomicroscopy and myringotomy findings (kappa=0.88, 95% CI: 0.80-0.96). CONCLUSIONS: Otomicroscopy performed by the specialist otolaryngologist is an accurate tool for the diagnosis of middle ear effusions. Otomicroscopy performed on the anaesthetised child achieves greater diagnostic accuracy than tympanometry and pneumatic otoscopy.

Osteoblast-like cell cultures from human stapes.

OBJECTIVE: In order to develop new middle ear prostheses for ossicular reconstruction it is important to study how the recipient middle ear tissues, especially the stapes footplate and superstructure, react to the implanted biomaterial. In this respect, animal studies and cell cultures using non-specific cells are of limited value. MATERIAL AND METHODS: The morphology and growth pattern of cells cultured from human stapes were studied. Cultured cells were examined for the presence of alkaline phosphatase and were processed for immunocytochemistry in order to detect the presence of osteocalcine. Fibroblast cultures served as controls. RESULTS: Cultured stapes cells proliferated in a polygonal-cubic shape and without any regular pattern in the culture. These cells were shown to contain alkaline phosphatase and osteocalcine. Cultured fascia fibroblasts proliferated in a spindle-shaped form and in a pattern resembling a shoal of fish. Cultured fibroblasts did not contain alkaline phosphatase or osteocalcine. CONCLUSIONS: It is possible to culture osteoblasts from human stapes. These cells can be characterized as osteoblast-like cells by means of their external shape and the presence of alkaline phosphatase and osteocalcine. Using these cultures, specific in vitro investigations concerning the interaction of biomaterials and middle ear ossicles could be performed.